Pricing and Reimbursement of Pharmaceuticals in the US: A Data-Driven Analysis

This report provides a detailed, data-driven analysis of pharmaceutical pricing and reimbursement in the US, focusing on Medicare Part D and Medicaid. Drawing on 2011-2023 expenditure, prescription and claimant data, it examines trends across both programs and offers an in-depth review of the top 50 branded drugs reimbursed under Medicare Part D in 2023.

Gain insight into expenditure patterns, variations in prescription volumes and claimant metrics, differences between Medicare and Medicaid reimbursement and the implications of recent policy developments, including the Inflation Reduction Act and the 2025 Executive Order, on high-cost drug pricing and negotiation.

Key Questions Answered:

• 1. What are the current trends in pharmaceutical pricing and reimbursement under Medicare Part D and Medicaid?
• 2. How has recent policy, including the Inflation Reduction Act and 2025 Executive Order, impacted high-cost drug pricing and reimbursement?
• 3. What are the expenditure patterns for the top 50 drugs reimbursed through Medicare Part D in 2023?
• 4. How do prescription volumes and claimant metrics vary among these top 50 drugs?
• 5. What are the key differences in drug reimbursement between Medicare Part D and Medicaid?
• 6. How do expenditure per prescription and per claimant compare across drugs and therapy areas?
• 7. How do manufacturer rebates and price concessions factor into the interpretation of expenditure data?
• 8. What are the projected trends in US pharmaceutical pricing and reimbursement through upcoming Medicare drug price negotiations?

Key Companies:

Methodology:

Dossier reports are developed from independent and concise analysis derived from original industry surveys and in-depth interviews with industry thought leaders. Reports analyse in detail significant developments and market trends that pharma executives need to understand if they are to manage the opportunities and challenges that lie ahead. The focus of each report is defined by a review of the secondary literature and any knowledge gaps identified. Based on this initial research, an evidence-based and expert-informed discussion guide is developed to ensure the research answers the most critical questions. Additionally, robust screening criteria are established to ensure that those interviewed are qualified in terms of their experience, knowledge and stature to speak on the topic.

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FirstWord Reports, a trusted industry leader with an exclusive focus on the pharmaceutical sector, delivers in-depth, actionable insights for biopharma professionals and decision-makers. Our deep industry knowledge enables us to provide relevant and valuable insights that help you identify emerging trends and navigate complex challenges effectively. Backed by extensive research and independent, impartial insights from leading experts and KOLs, our reports deliver the accuracy and reliability you need. With exclusive access to interviews and data unavailable elsewhere, along with ongoing market monitoring, we give you a comprehensive view of market dynamics. Covering over 40 dynamic disease areas and providing physician intelligence, including KOL insights and quantitative physician surveys, as well as industry expert views on issues in medical affairs, digital health, sales & marketing, market access, and other areas, our reports empower you to make smarter, data-driven decisions and maintain a competitive edge in a fast-moving industry.